Vertigo Flashcards
vestibular neuritis/acute labryinthitis (‘ear flu’)
viral SC infection or CN VIII infection; URTI-associated
acute; 3-4 day duration
severe vertigo, N&V, nystagmus, balance/unstable; no tinnitus
Rx: supportive; vestibular sedation, anti-emetics etc
labyrinthitis
URTI-associated; inner ear inflammation;
other causes: OM, sepsis, bacteraemia
vertigo lasting days/weeks; can be disabling; residual V w/ movement for months; decreasing severity and frequency until resolved
can cause hearing loss and dead labyrinth
Rx: ABx, V sedatives, rest
Cooksey-Cawthorne to aid labyrinth compensation
labyrinthine failure
idiopathic (commonest), viral, vascular occlusion, AI, temporal fracture, 2o bacterial
severe vertigo + acute SNHL, N&V, nystagmus, distress
(often bed bound and afraid to move)
10 days - 3 week duration; SNHL may not improve
Rx: symptomatic, sedatives, plasma expanders + carbogen (CO vdil), steoids/ciclo (?AI)
Meniere’s
hours/days duration, aura (whoosh/underwater), N&V, nystagmus
triad (Repeated): severe vertigo, hearing loss (low freq), tinnitus +/- ‘fullness’
positive rhomberg (vestibular system lost)
high pressure cochlear endolymph, also affects vestibular system
often asymmetrical, and FHx
Audiogram: temporary low frequency loss (800-1500 Hz); gradual SNHL
Rx: symptoms; sedate SC; ?salt reduction; gent/surgery to kill labyrinth
BPPV - commonest cause of vertigo
seconds/minutes, after head movement, no other Sx
dislodged stone from copula into SC; increased movement sensitivity
DDx: postural hypotension
Dix-Holpike manoeuvre: nystagmus; latent, geotrophic, fatigable
Rx: Epley’s/CC/Brandt-Daroff manoeuvre to reposition stones; self-resolves over 12-18months
presbystasis
centrally-caused transient unsteadiness
no LOC, N&V, or tinnitus
self-resolving
vestibular migraine
rare peripheral vertigo
PMH of migraines
treatment resistant
Rx: empirical amitriptyline nocte
vestibulopathy (benign)
middle-aged patients
clusters of isolated vertigo
spontaneously resolves in ~2years
Rx: reassure + cawthorne-cooksey exercises
syncope vs. vertigo
syncope: transient LOC, may be dizzy, SANS’
- HTN/Rx, arrhythmia, vasovagal, drugs, hyperventilation
vertigo: sensation of self/room spinning
- often with N&V, and pallor
peripheral vs. central
peripheral: labyrinth/vestibular
- sudden onset, N&V, SNHL + tinnitus if cochlea involved
central: brainstem, nuclei, higher centre
- transient balance issues
- no N&V, SNHL, or tinnintus
- SOL, trauma, egeneration, intoxication, small vessel disease, TIA, presbystasis
nystagmus - degrees
3rd: 3 positions (L/R/F); acute
2nd: 2 positions (F + L or R); subacute (Days)
1st: 1 position (Left or right); subacute (weeks)
nystagmus - causes
resolves in a few months (CNS compensation)
or permanent 1st degree even if no optic input (also no caloric response)
vestibular pathology: fast and slow phases
peripheral: horizontal or rotatory; inflam (ipsi), Cb lesion (ipsi), labyrinth (contra), otoliths (ipsi)
central: vertical/changing direction
spontaneous: physiological if iris past lacrimal sac; caloric response (COWS)
History questions
duration, pattern, triggers
other symptoms: migraine, CNS, hearing, N&V, tinnitus
medications
Investigations
ear examination: OM can cause
nystagmus: indicates vestibular cause (labyrinth/Meniere’s)
CN V/CN VII: neuromas; also check CN IX-XI
cerebellar function: past-pointing, Romberg
Dix-Hallpike: ?BPPV
management
anti-emetics: bucastem/prochlorperazinr, beta-histine, cinnarizine (Good for vertigo)
amitriptyline and cyclin if resistant
vestibualr sedatives: diazepam (not for BPPV - slows compensation)
supportive: IVF, rest
Phyio/vestibular rehab: balance training
GP for 6/12 before ?ENT referral; 90% resolve
